Obamacare: Kill or cure?

Aug. 23, 2009

Updated Aug. 21, 2013 12:28 p.m.

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A person who is against President Barack Obama's health care proposal holds a sign that is supposed to depict him as The Joker during a forum at the South County Civic Center August 20, 2009 in Delray Beach, Florida. The forum was hosted by U.S. Reps. Robert Wexler (D-FL) and Alcee Hastings (D-FL) to discuss the proposed changes to the U.S. health care system. Photo by Joe Raedle/Getty Images

Jim Elder of West Palm Beach, Fla., a supporter of health care reform, left, argues with an opponent who did not wish to be named, right, following the Florida Alliance for Retired Americans fifth annual town hall meeting on health care reform in Delray Beach, Fla. Thursday Aug. 20, 2009. (AP Photo/Lynne Sladky)

Demonstrators stage a rally against health care reform before a discussion on health care by U.S. Rep. Robert Wexler, D-Fla., at the South County Civic Center in Delray Beach, Fla. on Thursday, Aug. 20, 2009. (AP Photo/The Palm Beach Post, Brandon Kruse) ** MAGS OUT; TV OUT; OUT TABLOIDS; NO SALES **

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A man uses a walker as he moves past demonstrators at a rally before a discussion on health care by U.S. Rep. Robert Wexler, D-Fla., at the South County Civic Center in Delray Beach, Fla. on Thursday, Aug. 20, 2009. (AP Photo/The Palm Beach Post, Brandon Kruse) ** MAGS OUT; TV OUT; OUT TABLOIDS; NO SALES **

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Demonstrators stage a rally before a discussion on health care by U.S. Rep. Robert Wexler, D-Fla., at the South County Civic Center in Delray Beach, Fla. on Thursday, Aug. 20, 2009. (AP Photo/The Palm Beach Post, Brandon Kruse) ** MAGS OUT; TV OUT; OUT TABLOIDS; NO SALES **

A person who is against President Barack Obama's health care proposal holds a sign that is supposed to depict him as The Joker during a forum at the South County Civic Center August 20, 2009 in Delray Beach, Florida. The forum was hosted by U.S. Reps. Robert Wexler (D-FL) and Alcee Hastings (D-FL) to discuss the proposed changes to the U.S. health care system.Photo by Joe Raedle/Getty Images

OK, it took a long cup of coffee but we did it - the Register's three editorial writers read the House version of the health care proposals under consideration. Each of us reviewed one-third of the 1,018-page bill and our analysis turned up a number of policy changes that have received limited coverage: A new, broader role for the IRS; significant expansion of Medicare, even as that program is supposed to be a source of funding; and many policy details still to be written by a post called "Health Choices Commissioner."

It's no surprise that our small "l" libertarian editorial group would favor market solutions [see specifics at ocregister.com/opinion and Alan Bock columns], but the proposed extent of government control is, as Steven Greenhut put it, "a nightmare."

Steve wrote: "All major legislation is mind-numbingly complex and open to interpretation and legal disputes. That's to be expected, and perhaps explains why the legislators who vote on these bills rarely have read them in their entirety (they rely on staff reports produced by their party caucus) or have any serious grasp of what's inside them. No one understands how any of this will eventually play out, which is why supporters of the House Democratic health bill try to stick to broad feel-good generalities, and opponents try to seize on issues such as "death panels" and hypothesize about what might happen once various lingo becomes the law of the land.

"I didn't find any specific nightmare language, although the whole thing is a nightmare. It reminded me about why central planning never works. Planners cannot possibly have the wisdom and knowledge necessary to manage something as important as the nation's health care system. More regulation and rules - which is what this House bill is about - will only gum up the system and reduce individual choices.

"There are only two choices for dealing with scare resources: pricing or rationing. Pricing simply means that prices rise and fall based on supply and demand. If prices can't do that, we end up with bureaucrats limiting care."

The first 340 pages:

Mark Landsbaum

Many Americans may assume this so-called "reform" health care bill is mainly stuffed with provisions to affordably care for their health. Not quite.

There are at least 48 pages specifically devoted to a new relationship for Americans with the IRS. Yes. The tax man. Starting at Title IV on page 167, we find page after page of "amendments to Internal Revenue Code of 1986."

"Why?" you might ask. Silly question. The government has no money to keep you healthy and cared for. So, it must first take money from you.

We suspect some people may suddenly get religion after discovering section (5)'s "Religious Conscience Exemption" to subsection (a)'s tax on individuals who don't want to opt in to what the government will determine to be "acceptable health care coverage."

There are a few other special exemptions from the "shared responsibility" tax for special people who don't sign up for the otherwise mandatory government-preferred coverage: those visiting the country. Or people who sneak into the country. Otherwise, you're pretty much either on the hook for the mandatory coverage, or get to do more business with the IRS, starting with a 2.5 percent tax on your personal income.

Someone counted the number of times the word "penalty"is used in this legislation. It's 156, or about once every six and a half pages. Clearly, the people who claim to have your best health in mind have thought of ways to encourageyou to go along.

"But how," you might ask, "can government force compliance?" Another silly question, it turns out. The word "tax"is mentioned 172 times. Some folks may squirm a bit once they see the provision to "enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice."

As Cornell law professor William Jacobson observed, the IRS would assume a key role monitoring and enforcing health care mandates by cross-checking individuals' income tax returns with their health coverage filings, an American first.

At times it's a bit difficult to remember these 1,018 pages are simply to "provide affordable, quality health care … and reduce the growth in health care spending." Perhaps that's because those are things more properly done by health care buyers and sellers, not the government.

That brings us to another of our least-favorite sections of the House legislation. Ultimate authority and decision-making power rests with the government, more precisely with the newest of Washington, D.C.'s czars, referred to somewhat ominously as "the Health Choices Commissioner."

The bill says it is "the Commissioner" who determines "applicable rules of the Commissioner," "as specified by the Commissioner." "The Commissioner shall establish a grace period," and "other benefits as the Commissioner may specify," "within such age categories as the Commissioner shall specify."

The middle section:

Alan W. Bock

President Barack Obama - who still hasn't produced or endorsed a specific health care restructuring bill - often speaks about "paying for" expanded health insurance coverage by finding savings in the Medicare program - with some estimates ranging up to $500 billion over 10 years. This has some older Americans feeling uncertain or even up in arms.

However, much of the middle section of the bill passed by the House Energy and Commerce Committee has to do not with finding savings in Medicare but with expanding the program. It's not easy to reconcile what seems to have been a long pent-up desire on the part of House Democrats to expand Medicare - bestowing government benefits almost always garners more votes than taking them away - with the promise to find savings. No doubt there are savings to be found - some estimate fraud rates of 10 percent to 15 percent - but this section of the bill goes in the opposite direction.

Sec. 1181, on p. 355, for example seeks elimination of the "coverage gap": "For each year beginning with 2011, the Secretary shall … increase the initial coverage limit and decrease the annual out-of-pocket threshold from the amounts otherwise computed until there is a continuation of coverage from the initial coverage limit for expenditures incurred through the total amount of expenditures at which benefits are available."

In Sec. 1191 Telehealth services to rural areas are "expanded and enhanced."

Sec. 1301 sets up a pilot program for "accountable care organizations" in 17 micromanaging pages. Sec. 1302 sets up a pilot program for reimbursing medical home services. This comes with a price tag of $200 million per year through 2014 and $125 million thereafter (sure).

Licensed family and marriage therapists and mental health counselors would be covered.

It takes more than 20 pages to set up a Center for Comparative Effectiveness Research, another controversial idea. But the legislation specifies that the center won't be able to mandate or deny coverage based on its result.

It takes 40 pages of new regulations and tons of required reports to improve transparency of information on skilled-nursing facilities.

You get the idea. There may be projected savings in Medicare and Medicaid somewhere in the bill, but the middle section mostly expands coverage and increases spending.

Back of the bill:

Steven Greenhut

I warned my Mom, an Obama supporter, that her planned knee-replacement probably wouldn't get approved in a bureaucratically controlled medical system, given that older people will be told that they don't need such operations when the costs are borne by "society." In a market system (our current system is a hybrid, with too much government control), you can get more of what you need.

This type of legislation is taking us toward more government control - that's clear from reading it. Here are some specifics.

The first section I read creates enhanced penalties for health care companies involved in the federal program that engage in fraud and abuse. The secretary may revoke the certification of a firm that makes false statements or submits a false claim, for instance. Of course, this is necessary in any federally funded program, but no matter how many inspectors or fraud investigators are dispatched, there's always lots of fraud. Officials believe if they create some anti-fraud department that they can magically make fraud go away; hence, politicians always look for savings in programs by cutting fraud. But the real problem is the federal funding itself - a pile of Other People's Money will never be spent as carefully as our individual money, and such piles bring out the hucksters.

The legislation offers additional student-loan funds for nurses- of particular interest to me given that I have a daughter in nursing school. The nursing situation in California is a testament to how terribly the government has messed up. In a nutshell, the state has enormous demand for nurses, exacerbated by a nurse/patient ratio law pushed by the unions. Meanwhile, the state has set up various impediments for people to attend nursing school (a lottery system in state schools, for instance). The result: nursing shortages and shutdowns of emergency rooms that can't recruit the right number of nurses. If the government wants to fix the nursing situation, it will take the deregulation of the system rather than an increase in loan funds.

If you believe that Congress and the Obama administration can fix American health care, forward me your e-mail, and I will put you in contact with a Nigerian man I've heard from who has an extra few million dollars he is trying to give away!

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